François Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced Hospitalization, ETC and Sleep Therapy
Edward Shorter’s comment on Luc Ciompi’s comments
Dr. Ciompi’s wise juxtaposition of social v biological psychiatry does account for much recent history, without quite hitting the nail on the head. In fact, there are different kinds of psychiatric disorders with different treatments. The major psychiatric illnesses, such as psychotic depression, melancholia, catatonia and mania, are brain diseases and they merit biological approaches, just as any biological disorder of the body merits a medical approach. You will not get your melancholic patients well again with psychotherapy or community day clinics.
Then there are a whole variety of stress-related illnesses that have nothing to do with brain disease but are caused by tension, unhappiness, misery and the host of calamities to which the flesh is heir. Psychological, social and community approaches have a decided role here, medications and “biology” much less so. These patients benefit greatly from psychotherapy and the simple application of human concern and kindness. Nor do they need psychiatrists, when social workers, psychiatric nurse practitioners and psychologists will serve very well.
Unfortunately, in discussions such as this one, brain-disease and stress-related illness are often lumped into one and the “social psychiatrists” and “biological psychiatrists” have a shoot out, which is more a dialogue of the deaf than a genuine confrontation.
In Geneva in the 1980s the social psychiatric approach ran amok and patients with brain illnesses were ill served, a violation of medical ethics (we believe that all patients deserve the most appropriate treatment for their condition). But the social zealots in Geneva hid the ECT machine! Unbelievable.
And today, we preach Prozac for all, similarly incredible.
From Geneva to Thomas Insel’s NIMH is a long way. But the trains run on parallel tracks, not on a collision course.
June 27, 2019